Ten-Year Follow-Up: Collagenase Injection Versus Open Surgery for Dupuytren’s Disease

Background: Dupuytren’s disease (DD) is a fibroproliferative disorder of the palmar fascia that results in progressive digital flexion contractures. Various treatment strategies have been developed to restore extension, ranging from minimally invasive collagenase clostridium histolyticum (CCH) injection to more invasive surgical procedures such as open selective aponeurectomy. While CCH has gained widespread adoption due to its limited invasiveness and rapid recovery, questions remain about its long-term durability compared with open surgery (OS). This study aims to compare long-term outcomes of CCH injection and OS in patients with stage 2 or higher single-digit DD, focusing on recurrence, patient satisfaction, complications, and return to work at least 10 years after treatment. Methods: A retrospective cohort study was conducted on patients treated in 2012 with either CCH injection or OS. All patients had at least stage 2 DD and at least 10 years of follow-up. The primary outcome was to compare recurrence rates between the two patient cohorts. Secondary outcomes included visual analogue scale (VAS) satisfaction, Michigan Hand Questionnaire (MHQ) scores, complications, and time to return to work. Results: A total of 97 patients completed 10-year follow-up (60 OS, 37 CCH). Recurrence at 7 years was relatively similar between groups. However, a pronounced divergence emerged between 7 and 10 years. At 10 years, recurrence occurred in 10 patients in the OS group versus 15 in the CCH group, with statistically significant differences overall (p = 0.0175) and particularly in the PIP subgroup (p = 0.0041). VAS satisfaction at 10 years was higher after OS (7.9 ± 1.5) than after CCH (6.4 ± 1.6), and return to work was significantly faster after CCH. MHQ scores were comparable. Conclusion: Both treatments provided acceptable patient satisfaction at 10 years; however, OS yielded better long-term recurrence rates and fewer complications. Although CCH offers rapid recovery, its durability beyond 7 years appears markedly inferior. These findings reinforce the need for careful patient selection and long-term counseling when considering minimally invasive treatment.